Provider Demographics
NPI:1548549108
Name:DRAINAS, EVANGELOS ARISTIDIS
Entity type:Individual
Prefix:
First Name:EVANGELOS
Middle Name:ARISTIDIS
Last Name:DRAINAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9368 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4610
Mailing Address - Country:US
Mailing Address - Phone:734-416-3900
Mailing Address - Fax:731-416-3904
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:#120
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1547
Practice Address - Country:US
Practice Address - Phone:248-347-1168
Practice Address - Fax:248-347-1252
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist